What can be a potential diagnosis associated with ST depression and T wave inversion without elevated biomarkers?

The presence of ST segment depression and T wave inversion without elevated biomarkers suggests that the heart is experiencing ischemia, but not to the extent of causing myocardial necrosis, which would elevate cardiac biomarkers. This pattern is consistent with stable angina, where episodes of ischemia occur during exertion and resolve with rest.

Stable angina typically presents as transient chest pain or discomfort induced by physical activity or emotional stress, and the ECG changes observed—like ST depression and T wave inversion—are indicative of subendocardial ischemia. It is important to note that in stable angina, the myocardial tissue remains viable, and thus, there is no associated elevation in cardiac biomarkers, as seen in more severe conditions.

In contrast, conditions such as NSTEMI and STEMI involve myocardial necrosis, which would result in elevated biomarkers, while unstable angina can cause similar ECG changes but often occurs without the sustained ischemic episodes typical of stable angina. Unstable angina can be associated with more severe and unpredictable ischemic episodes, but it typically occurs in situations where some degree of myocardial damage may occur, even if biomarkers remain normal at times.

Therefore, the best fit for ST depression and T wave inversion without elevated biomarkers is stable angina, as